Treatment: Allergic Rhinitis

• Older antihistamines (e.g., chlorpheniramine, diphenhydramine) are effective but cause sedation and psychomotor impairment including reduced hand-eye coordination and impaired automobile driving skills. Newer antihistamines (e.g., fexofenadine, loratadine, desloratadine, cetirizine, levocetirizine, olopatadine, bilastine, and azelastine) are equally effective but are less sedating and more H₁ specific.
• Oral sympathomimetics, e.g., pseudoephedrine 30-60 mg PO qid; may aggravate hypertension; combination antihistamine/decongestant preparations may balance side effects and provide improved pt convenience.
• Topical vasoconstrictors—should be used sparingly due to rebound congestion and chronic rhinitis associated with prolonged use.
• Topical nasal glucocorticoids, e.g., beclomethasone, two sprays in each nostril bid, or fluticasone, two sprays in each nostril once daily.
• Topical nasal cromolyn sodium, one to two sprays in each nostril qid.
• Montelukast 10 mg PO daily is approved for seasonal and perennial rhinitis.
• Hyposensitization therapy, if more conservative therapy is unsuccessful.